Effects of Comprehensive Correcting Exercise Program and Mckenzie Exercises in Patients With Sternosymphyseal Syndrome

A Randomized Clinical Trial will be conducted at Horizon Hospital Physiotherapy Department and Riphah Clinic Lahore through consecutive sampling technique on 36 patients which will be allocated using simple random sampling through sealed opaque enveloped into Group A and Group B. Group A will be treated with comprehensive correcting exercise program (three times a week for 6 weeks) into 3 phases with different intensity and frequency. Group B will receive the McKenzie's method of exercises that include Deep neck flexor (chin tucks), Shoulders shrug McKenzie exercise for neck, Repeated shoulder flexion/Extension, Neck flexion McKenzie exercises. Outcome measure will be conducted through pain and functional disability Index through questionnaire and craniovertebral angle through PhysioMaster/APECS, Thoracic kyphosis through Inclinometer and Range of motion via goniometer.

Study Overview

• Status: Completed
• Conditions: Sterno Sympheseal Syndrome
• Intervention / Treatment: Other: comprehensive correcting exercise program; Other: McKenzie's method of exercises

Detailed Description

Sternosymphyseal syndrome is a postural syndrome involves excessive lumbar and thoracic kyphosis, a forward drawn head, and hyper-lordosis of the cervicocranial junction. This posture is associated with increased muscular tension and faulty respiration habits. When the slumped posture is assumed for sustained periods of time, increased load is placed on the intervertebral disc. With the sternum approximating the pubic symphysis, diaphragmatic inhibition results in over-activation of scalene and upper trapezius musculature during respiration. This muscle tension is reversible by merely having the patient sit up straight. (Brugger's relief position).

A Randomized Clinical Trial will be conducted at Horizon Hospital Physiotherapy Department and Riphah Clinic Lahore through consecutive sampling technique on 36 patients which will be allocated using simple random sampling through sealed opaque enveloped into Group A and Group B. Group A will be treated with comprehensive correcting exercise program (three times a week for 6 weeks) into 3 phases with different intensity and frequency. Group B will receive the McKenzie's method of exercises that include Deep neck flexor (chin tucks), Shoulders shrug McKenzie exercise for neck, Repeated shoulder flexion/Extension, Neck flexion McKenzie exercises. Outcome measure will be conducted through pain and functional disability Index through questionnaire and craniovertebral angle through PhysioMaster/APECS, Thoracic kyphosis through Inclinometer and Range of motion via goniometer.

• Study Type: Interventional
• Enrollment (Actual): 36
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab
    • Lahore, Punjab, Pakistan, 54000
      • Physiotherapy department of Horizon Hospital and Riphah International clinic Lahore.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age between 18-28
• Both gender male and female
• Participants who have any distance from xiphoid process to pubic symphysis less than 18cm (11 inches)
• Participants with forward head (≥ 44°), round shoulder (≥ 49°) or excessive thoracic kyphosis (≥ 42°) will be measured by photography and flexicurve. Patient agree to sign written consent

Exclusion Criteria:

• Subjects younger than 18 years of age, cardiac, respiratory, kidney, circulatory problems, systemic disease, diabetes
• Any trauma or localized infection in neck region
• Pregnancy or suspicion of pregnancy for female subjects.
• A history of fractures, treatment or surgery to the lumbar, thoracic, cervical spine and upper limbs
• Thoracic outlet syndrome.
• Any shoulder pathology causing limitation of movement.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: comprehensive correcting exercise program; Group A will be treated with comprehensive correcting exercise program (three times a week for 6 weeks) into 3 phases with different intensity and frequency	Other: comprehensive correcting exercise program; Group A will be treated with comprehensive correcting exercise program (three times a week for 6 weeks) into 3 phases with different intensity and frequency
Experimental: McKenzie's method of exercises; Group B will receive the McKenzie's method of exercises that include Deep neck flexor (chin tucks), Shoulders shrug McKenzie exercise for neck, Repeated shoulder flexion/Extension, Neck flexion McKenzie exercises	Other: McKenzie's method of exercises; Group B will receive the McKenzie's method of exercises that include Deep neck flexor (chin tucks), Shoulders shrug McKenzie exercise for neck, Repeated shoulder flexion/Extension, Neck flexion McKenzie exercises

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Inclinometer	The thoracic kyphosis will be measured by using an inclinometer. The feet of inclinometer will be placed on the spinal vertebrae which will be palpated first	6 WEEK
Numeric pain rate scale (NPRS)	Patient level of pain will be assessed using this 11-point NPRS scale (0-no pain, 10-most intense pain) is the most commonly used version which has good test-retest reliability (r=. 79-. 96) This scale ranges from 0 to 10	6th week

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neck Disability Index	This questionnaire will be used to assess disability. It comprises of 10 items; 7 related to daily living activities, 2 related to pain and 1 related to concentration. Each item is scored from 0 to 5. Total score is expressed as a percentage, with higher scores related to greater disability (24). The 10 items, with 6 possible answers in each are scored 0 (no activity limitations) to 5 (major activity limitations) and summed up to yield a total score.	6 WEEK

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Rabiya Noor, PhD, Riphah International University

Publications and helpful links

General Publications

• Page P. Shoulder muscle imbalance and subacromial impingement syndrome in overhead athletes. Int J Sports Phys Ther. 2011 Mar;6(1):51-8.
• Morris CE, Greenman PE, Bullock MI, Basmajian JV, Kobesova A. Vladimir Janda, MD, DSc: tribute to a master of rehabilitation. Spine (Phila Pa 1976). 2006 Apr 20;31(9):1060-4. doi: 10.1097/01.brs.0000214879.93102.4e.
• Czaprowski D, Stolinski L, Tyrakowski M, Kozinoga M, Kotwicki T. Non-structural misalignments of body posture in the sagittal plane. Scoliosis Spinal Disord. 2018 Mar 5;13:6. doi: 10.1186/s13013-018-0151-5. eCollection 2018.

Study record dates

Study Major Dates

• Study Start (Actual): October 15, 2024
• Primary Completion (Actual): November 10, 2024
• Study Completion (Actual): November 20, 2024

Study Registration Dates

• First Submitted: December 20, 2024
• First Submitted That Met QC Criteria: December 27, 2024
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: December 27, 2024
• Last Verified: December 1, 2024

More Information

Terms related to this study

• Keywords: Range of Motion; Functional Disability; Thoracic kyphosis; Corrective exercises; McKenzie exercises
• Additional Relevant MeSH Terms: Pathologic Processes; Disease; Syndrome
• Other Study ID Numbers: REC/RCR&AHS/24/0109

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No